Effective Fall 2013 Application Student Name: ___________________________________
SCORE CRITERIA POINT DISTRIBUTION REQUIRED SUPPORTING DOCUMENTATION
1. Previous academic degrees or diplomas (Maximum Points =5) 1A. BS/BA or higher OR AA/AS Degree
Check box for Degree BS/BA AA/AS 5 Official transcript from regionally accredited U.S. colleges or universities with degree posted.
OR 1B. Foreign Degree equivalent to BS/BA
degree 1 All transcripts from outside the United States must be evaluated by a
CHABOT- approved foreign evaluation service. See counselor for listing.
2. Relevant health care license or certificate held by an Student (Maximum Points = 6) 2A. License Health Care Worker (i.e. LVN,
Paramedic, Psychiatric Technician,
Radiologic Technician or Surgical Technician) Work* experience is required in direct patient care > 1000 hours within the last 18 months.
*Work must be documented paid hours not volunteer hours.
6
Check box for current license
LVN Psych Tech
Paramedic
Radiologic Tech
Surgical Tech with
License
Licensed healthcare worker requires a copy of your current picture ID California License, date of issue, and date of expiration.
Work: Letter from current/former employer verifying employment in a position under your current license. The letter must be on organization letterhead with an original signature* and must include Student’s name, start date and end date (if applicable), employee status (full-time/part-time), number of hours worked per week (or total hours from/to date), job title, department if applicable and last paystub.
OR 2B. Certificated Health Care Worker i.e. Allied Health Certificate
Work* experience is required in direct patient care > 1000 hours within the last 18 months.
3
CNA MA
Other ____________
Certificated healthcare worker requires a copy of your current California or National certificate including your certificate number, date of issue and date of expiration.
Work: Letter from current/former employee verifying employment in a position under your current certificate. See 2A above for letter definition.
Refer to http://www.caahep.org/Content.aspx?ID=19 for comprehensive Allied Health jobs titles
3. Grade point average in relevant course work (3A = 40 point Max + 3B = 10 points Max = Maximum Points = 50) 3A. Minimum 2.5 GPA in Science
Prerequisites: Anatomy, Physiology, and Microbiology.
Only one “C” grade allowed.
No more than one withdrawal or repeat of any substandard grade in the above listed science prerequisite will be allowed. Students who have withdrawn or repeated any science prerequisite must deduct 2 points from their score
40 Points Max GPA 4.00 – 3.90 GPA 3.89 – 3.70 GPA 3.69 – 3.50 GPA 3.59 – 3.40 GPA 3.39 – 3.30 GPA 3.29 – 3.10 GPA 3.09 – 3.00 GPA 2.99 – 2.80 GPA 2.79 – 2.60 GPA 2.59 – 2.50
40 36 32 28 24 20 16 12 8 4
Official transcripts (in original sealed/unopened envelope) for all lower and upper division courses completed at any and all regionally accredited U.S.
institutions, regardless of applicability to nursing requirements will be required. Transcripts will not be required for courses completed at CHABOT or LAS POSITAS.
All transcripts from outside the United States must be evaluated by a CHABOT-approved foreign evaluation service.
Courses completed at other regionally accredited United States colleges or universities must be equivalent to Chabot College courses.
Chabot College Nursing Program ADN Criteria - Effective Fall 2013 Application
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SCORE CRITERIA POINT DISTRIBUTION REQUIRED SUPPORTING DOCUMENTATION
Section 3 continued Withdrawal
Repeat D/F -2 -2
All prerequisite courses must be completed with a grade of “C” or better and the final grade must be posted on the transcript. For any course in which a grade of “C” or better was earned, the EARLIEST course grade will be utilized.
Failure to submit transcripts with all grades posted will result in disqualification from the application process.
3B. Overall average GPA in FIXED courses:
English 1A, Sociology 1, Psychology 1, and Communications 1, 10 or 30
(Equivalent courses will be accepted.)
GPA 4.0 - 3.80 GPA 3.79 - 3.50 GPA 3.49 - 3.00 GPA 2.99 - 2.50 GPA 2.50 - 2.00
10 8 6 4 2
Fixed Courses are courses required for an AA degree in nursing and are also required by the Board of Registered Nursing. Fall 2013 Students will be required to complete these courses in addition to the science prerequisites listed in 3A.
Effective Fall 2014
ADD 3C – Statistics Note: other sections will be reduce to accommodate these additional points.
C or Better 5 This will ease transition to a BSN program after graduation.
Course must meet CSUEB transfer standards.
4. Life experiences or special circumstances of an Student (Maximum Points = 2 Points) 4A. Disabilities (Same meaning used in Section
2626 of the Unemployment Insurance Code)
2 Documented disability from college Learning Disability Program or Disability Support Programs & Services.
Visit: http://www.edd.ca.gov/unemployment Search for Unemployment Insurance Code Section 2626.
OR 4B. Low family income (Eligibility for, or receipt of, financial aid under a program that may include, but not limited to, a
fee waiver from the Board of Governors, the Cal Grant Program, the federal Pell Grant program or CalWORKs)
2 Proof of eligibility or proof of receipt of financial aid (e.g. BOG fee waiver, Cal Grant, Pell Grant or other federal grant, CalWORKs).
OR 4C. First generation to attend college 2 Complete the ADN Admission Supporting Documentation Form explaining situation or circumstances.
OR 4D. Need to work (Need to work means student is working at least part-time while completing academic work that is
prerequisite for the Nursing Program) Continued on next page
2 Paycheck stub during period of time enrolled in prerequisite courses or letter from employer (must be on organization letterhead) verifying employment was at least part-time while completing prerequisite courses.
*Students may work during the program but are strongly encouraged not to work or reduce their hours.
7. Approved diagnostic Assessment Tool (Maximum points = 30) Test of Essential Academic Skills TEAS ®
Version V offered through Assessment Technologies Institute (ATI).
Only the first passing score will be counted towards ranking.
If student scores below 62% on their first attempt, remediation is required before retaking the test. The student is not eligible for the Fall program and must reapply.
Score 98 to 100 97.9 to 95 94.9 to 93 92.9 to 90 89.9 to 87 86.9 to 84 83.9 to 81 80.9 to 78 77.9 to 75
Pt 30 28 26 24 22 20 18 16 14
Score 74.9 to 72 71.9 to 69 68.9 to 66 65.9 to 62
Pt 12 10 8 5
If selected, an official copy must be sent directly to the Chabot Nursing Program for confirmation. To obtain an official copy, go to www.atitesting.com , sign in and request a copy be sent to Chabot College.*
*If tested through Chabot College your test will be on file.
You do NOT need to submit another copy.
SCORE CRITERIA POINT DISTRIBUTION REQUIRED SUPPORTING DOCUMENTATION
OR 4E. Disadvantaged social or educational environment
2 Participation or eligibility for Extended Opportunity Programs & Services (EOPS), PUENTE, ASPIRE, EXCEL, or DARAJA.
OR 4F. Difficult personal and family situation/circumstances
2 Complete ADN Admission Supporting Documentation Form explaining situation or circumstances.
OR 4G. Refugee status 2 Documentation or letter from United States Citizens and Immigration Service
(USCIS).
5. Military Service (Maximum Points = 5 Points)
Veteran Status 5 Copy of Defense Department Form DD214. Honorable Discharge required.
6. Proficiency or advanced level coursework in languages other than English (Maximum Points = 2 Points) Proficiency (reading/writing/speaking) in a
language other than English 2
Official transcript from a U.S. regionally accredited college or university verifying four (4) semesters of foreign language – OR – Verification of proficiency – Complete the ADN Admission Supporting Documentation Form.
TEAS – Student are NOT required to take the test to apply.
Students will be evaluated on all criteria (Steps 1-6) above and ranked for selection. Top 120 Students will be
asked to submit an original TEAS version V from ATI Testing or take the TEAS exam at Chabot College in May.
Using the following scoring these students will then be ranked for selection. Top 50 students in point total will
be selected and next 60 will be alternates.
Chabot College Nursing Program ADN Criteria - Effective Fall 2013 Application
2013_CriteriaChabotCollege_FinalF2013 Edit: 9/21/2012 4:31 PM Page | 4
Section Covers Max Points Your Total Program Items
Total of 50 students are selected one time each year in May for the next Fall enrollment.
Students are divided into two pools; 40 Students selected for Hayward campus: WEST of Castro Valley and 10 Students selected for Livermore campus: EAST of Castro Valley.
Students will then be RANKED by Criterion score* calculated above, if all paperwork including transcripts has been received as required. There is no minimum point total for Fall 2013.
If the pool consists of several students earning the same criterion score those students will enter a random pool for RANKING.
If not selected students must reapply each year. We do not maintain a waitlist of Students.
*Criterion Score may be modified each year to meet the student and program standards.
Section 1 Academic 5
Section 2 HealthCare 6 Section 3A Sciences 40 Section 3B General Ed 10 Section 4 Life Experience 2
Section 5 Military 5
Section 6 Language 2
Sub Total 70
Section 7 TEAS Score: 30
Please enter points earned, sign and submit 6 pages with your application confirmation page.
Total Earned 100
Student Signature
ADN Admission Supporting Documentation Form
2013_CriteriaChabotCollege_FinalF2013 9/21/2012 4:31:11 PM
Student Name: Student ID #
Last, First Name
Maximum Points earned is 2 Attention Please PRINT
Criteria 4C. First generation to attend college. Please briefly explain your situation or circumstances:
Criteria 4E: Difficult personal and family situation/circumstances. Please briefly explain your situation/circumstances:
Criteria 6: Verification of proficiency in a foreign language outside of college coursework. Please PRINT! Maximum 2 points I verify that I am proficient in
Language (s)
at a level that allows common everyday communication.
I am proficient in (Selection all that apply) SPEAKING READING WRITING Please explain your level of proficiency and how you acquired this language. (50 words or less)
Student’s Acknowledgement
I certify that all information I have provided is complete and accurate to the best of my knowledge. I understand that falsification of any information will result in my disqualification from candidacy or if selected, dismissal from the program.
Print Student Name, Student Signature Date Blue INK ONLY Date
Chabot College – Nursing Program
ADN Admission Supporting Documentation Form
2013_CriteriaChabotCollege_FinalF2013 9/21/2012 4:31:11 PM
CERTIFICATION OF LANGUAGE PROFICIENCY
(Optional Form) To be submitted with the Nursing Application
Instructions to the Student:
This form is OPTIONAL and is not required to be considered for admission to the Nursing degree program.
Section I: Enter your name below and follow the directions.
Section II: Ask a member of your community (not your close family) to complete this section. PLEASE PRINT.
SECTION I: STUDENT INFORMATION
Student Name: Student ID #: W
STUDENT CERTIFICATION OF PROFICIENCY LANGUAGE:
English is 1st Language or 2nd Language SECTION II: THE PERSON COMPLETING THIS LANGUAGE PROFICIENCY CERTIFICATION:
A) Person must be fluent in the identified foreign language and
B) Person must also have known the Student and observed his/her language skills in the past year.
Please complete the following:
Name: Phone:
Title: Organization:
Address:
City ST/Zip:
Q1: How long have you known the Student and in what capacity?
Q2: How often have you observed the Student conversing/translating in this language?
Daily 2 days/week 1 day/week Other:
In each of the following questions, please rate the Student on a scale from 1 (low) to 5 (high):
1 = inadequate second language proficiency for professional communication 3 = able to translate in a medical emergency
5 = highly competent in speaking and writing proficiency
Q3: Student's proficiency in speaking this language is: 1 2 3 4 5
Q4: Student's proficiency in writing this language is: 1 2 3 4 5
Q5 Student's proficiency in reading this language is: 1 2 3 4 5
x
Signature (Section II) Date
